In order to better understand the clinical manifestation of systemic lupus erythematosus (SLE) with intracranial hypertension syndrome (IHS), we analyzed the clinical features and treatment of a typical SLE patient with IHS. SLE is one of the most unpredictable autoimmune diseases involving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei. IHS is an uncommon manifestation of neuropsychiatric SLE (NPSLE) and is characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. IHS has been reported in a few sporadic cases in patients with SLE worldwide, but rarely has been reported in China. In this study, a 34-year-old female SLE patient with IHS was reported and pertinent literature reviewed. The clinical presentation, image logical features, and investigatory findings were discussed.
Diagnosis, Differential ; Intracranial Hypertension/diagnosis ; Intracranial Hypertension/*etiology ; Lupus Erythematosus, Systemic/*complications ; Lupus Erythematosus, Systemic/diagnosis

OBJECTIVE:To provide reference for rational use of Chinese patent medicine. METHODS:The influencing fac-tors of rational use of Chinese patent medicine was investigated in respects of the selection of Chinese patent medicine,drug combi-nation,usage and dosage,clinical evaluation,pharmacoeconomic evaluation. RESULTS&CONCLUSIONS:Chinese patent medi-cine is a characteristic product of traditional Chinese medicine. It is a complex and important issue to use Chinese patent medicine rationally. It should be considered in many ways,not only pay attention to the principle of clinical use of Chinese patent medicine, but also need to carry out clinical evaluation of Chinese patent medicine;at the same time,the economics of Chinese patent medi-cine should be focused on.

Methods The clinical data of 4445 cases (5 530 hernias) who underwent LIHR at Ruijin Hospital from Jan 2001 to Dec 2015 were analyzed retrospectively.2 125 cases underwent 2 402 trans-abdominal preperitoneal procedure(TAPP),2 306 cases did 2 907 totally extraperitoneal (TEP),and 21 IPOMs in 20 cases.There were 3 216 indirect hernias (60.3％),1 164 direct hernias (21.8％),399 recurrent hernias (7.5％),479 complex hernias (9.0％),and 72 femoral hernias (1.4％).The median time of follow-up is 51 months with a range between 7 and 187 months.Results The average operation time was 27.1 ± 8.7 min for unilateral hernia repair,and 43.0 ± 11.0 min for bilateral hernia repair.The average hospital stay was 1.4 ± 1.1 d.There were 250 seroma (4.7％),68 urinary retention (1.3％),23 transient neuropraxia (0.4％) and 3 paralytic obstruction of intestines (0.1％).Severe complications included 1 port site hernia,1 intestinal injury,and 1 mechanical intestinal obstruction.After a medium follow-up of 51 months,there were 13 recurrent cases (0.24％),including 5 cases after TAPP,7 after TEP,1 after IPOM.Conclusion LIHR is a safe and efficient technique for hernia repair.

Pseudomonas sp. M18, one of plant-growth-promoting rhizobacteria, can produce secondary metabolites including phenazine-1-carboxylic acid (PCA) and pyoluteorin (Plt). PA2572 gene coding protein is a probable two-component response regulator in Pseudomonas according to homologous speculations. In order to investigate its genetic function, PA2572 homologous gene, ppbR, was amplified from M18 genome, inactivated by inserting a Gm cassette. The resulting reconstruct was introduced into the M18 genome using homologous recombination technique, so as to obtain the null mutant M18P. The results showed that the M18P has less flagellar swimming and swarming motility, and yielded fewer PCA. The production of PCA was only 50% of the wild type. However, there was no remarkable difference between mutant and wild type in producing pyoluteorin in KMB medium.

OBJECTIVETo evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor.

METHODSFrom January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients, 30 patients were male, and 12 patients were female, ranging in age from 28 to 76 years old, with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes, and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment, 6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits, and 5 patients had injuries of A degree, 3 patients had injuries of B degree, 4 patients had injuries of C degree, 6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression, tumor curettage and total vertebrectomy, which were decided based on Tomita classification. The pain, spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week, 3 months, 6 months, 1 year and 2 years after operation.

RESULTSOne patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise, 17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months, with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months, 6 months, 1 year and 2 years were 95.2%, 85.7%, 58.2%, 37.6% respectively.

CONCLUSIONAccording to Tomita system, the different surgical treatments can be selected for patients with spinal metastatic tumors, which can relieve pain, improve the neurological status and spine stabilization, maintain local control, improve quality of life.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Neoplasms ; diagnosis ; secondary ; surgery ; Thoracic Vertebrae ; Treatment Outcome

OBJECTIVETo evaluate the feasibility and clinical value of whole body diffusion weighted magnetic resonance imaging (WB-DWI) in detection of bone metastases.

METHODSTotally 38 patients with malignant tumors and suspected bone metastases were enrolled. All patients underwent WB-DWI and bone scintigraphy within 2 weeks. The skeletal system was divided into 13 regions: skull, sternum, clavicle, cervical spine, thoracic spine, lumbar spine, sacrum, ribs, pelvic bone, scapula, humerus, femur, and tibia/fibula. Bone metastases were assessed for both modalities in a separate consensus reading and apparent diffusion coefficient (ADC) values were calculated.

RESULTSWB-DWI identified 214 pathological lesions in 20 patients, while bone scintigraphy demonstrated 197 lesions in 20 patients. Concordance between WB-DWI and bone scintigraphy occurred in 34 of 38 patients. There was no statistical difference between these two modalities (P = 0.488). Compared with bone scintigraphy, the regions missed by WB-DWI were mainly located in skull, thoracic spine, humerus, and tibia/fibula. WB-DWI was more sensitive in the detection of metastases to the cervical spine, lumbar spine, sacrum, pelvis, ribs and femur. No statistical significance was found among the ADC values of bone metastases in different skeletal areas, and the mean ADC value was (0.75 +/- 0.10) x 10(-3) mm2/s. Furthermore, WB-DWI revealed more metastases to the lymph lodes and extraskeletal organs. Conclusion WB-DWI has high accordance with skeletal scintigraphy in detecting bone metastases, and the two modalities are complementary to each other.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; secondary ; Diffusion Magnetic Resonance Imaging ; methods ; Feasibility Studies ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Radionuclide Imaging ; Stomach Neoplasms ; pathology ; Whole Body Imaging ; methods ; Young Adult

Objective To assess the clinical efficacy and adverse reac-tions of olanzapine combined with escitalopram oxalate on depressive disorder in elderly patients.Methods Sixty two elderly patients with depressive disorder were recruited from February 2012 to April 2014 in our hospital and were randomized divided into the control group ( n=33 ) and experiment group ( n=29 ).Patients in the control group were given escitalopram oxalate 10 mg · d-1 orally for 8 weeks and patients in the experiment group were given escitalopram oxalate 10 mg · d-1 combined olanzapine 2.5 mg· d-1 ( initially) ,ranging from 5 to 10 mg· d-1 within the first week.The data of hamilton depression scale ( HAMD) and treat-ment emergent symptom scale ( TESS ) score were recorded between the two groups to evaluate the clinical efficacy and adverse reactions before treatment and 1, 2, 4, 6 and 8 weeks after treatment.Results From the end of the second week to the eighth week , the HAMD scale were significantly decreased in both groups ( P <0.05 ).At the end of the fourth week to the eighth week , the HAMD score in the experiment group were significantly lower than those in control group ( P <0.05 ).After 8 weeks, more than 10%patients in the experiment group showed weight gain , higher than those in the control group (P<0.05).The other adverse reactions such as dizziness , dry mouth, constipation and nausea showed no statistical differences( P>0.05 ).Conclusion Olanzapine combined with escitalopram oxalate in the treatment of depressive disorder in elderly patients can rapidly improve the symptom and have better clinical efficacy , but the weight gain was a common adverse reaction.

OBJECTIVETo design and manufacture a new custom-made artificial articular cartilage of femoral condyle based on rapid prototyping technique and explore a method to solve the necroses of allocartilage in hemi joint allotransplantation.

METHODSDesign the new custom-made artificial articular cartilage of femoral condyle. The allograft and the patient distal femurs were scanned with Picker 6000 spiral computed tomography (CT) with 1.0 slice thickness and pitch of 1.5, reconstructed the distal femurs in Voxel Q image workstation with volume rendering technique. Then downloaded the transaxial 2D image data to personal computer at 0.1 mm interval and converted it into 2D digitized contour data by using image processing software developed by our team. The 3D wire frame and solid images of femoral condyle could be reconstructed when the 2D digitized contour data were input into image processing software Surfacer 9.0 (Imageware Company, USA). Subsequently based on the clinical experience and the need of design, the 3D contour image of articular cartilage was extracted from the surrounding. Based on the extracted 3D contour image, the computer-aided design (CAD) of the custom-made artificial articular cartilage was accomplished in Surfacer software, converted the CAD model into RP data format. Standard triangularization language, imported into the LPS600 rapid prototyping machine (Hengtong Company, Xi'an Jiaotong University, China), and the resin prototype was achieved. Then the resin model was used as a positive mould to build up a silica gel negative mould, the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it. A patient was selected to clinical applying.

RESULTSA new custom-made artificial articular cartilage of femoral condyle was made. It was press-fit well to the subchondral bone of the allograft bone. The patient's one and half year follow-up result was excellent.

CONCLUSIONSWe design and manufacture a new custom-made artificial articular cartilage of femoral condyle based on rapid prototyping technique. The result shows that the manufacturing process has the advantage of rapidness and precision that are very important for individualized artificial implant manufacturing. The artificial articular cartilage is press-fit well and could be a good idea to solve the necroses of allocartilage in hemijoint allotransplantation.

Adolescent ; Arthroplasty, Replacement, Knee ; Bone Transplantation ; Cartilage, Articular ; Computer-Aided Design ; Femoral Neoplasms ; surgery ; Follow-Up Studies ; Humans ; Knee Prosthesis ; Male ; Neoplasm Recurrence, Local ; surgery ; Osteosarcoma ; surgery ; Prosthesis Design ; methods ; Transplantation, Homologous

OBJECTIVETo study therapeutic effects of limited internal fixation combined with external fixation in the treatment of deformity of distal end of femur, as well as to explore its effect on the function of knee joint.

METHODSFrom June 2004 to June 2009, 38 patients with deformity of distal end of femur were treated with osteotomy at femoral supracondylar and internalfixation combined with hybrid external fixator. Among the patients, 19 patients were male and 19 patients were female, ranging in age from 14 to 58 years, with an average of 26 years. Six patients had genu valgum, 4 patients had varus of the distal end of femur, 2 patients had varus combined with rotation deformity,3 patients had genu recurvation and 23 patients had deformity of genuflex. The function of knee joint was evaluated according to Dimeglio clinical assessment after the treatment.

RESULTSAll the patients were followed up and the during ranged from 6 to 48 months, with a mean period of 23 months. All the deformity obtained satisfactory correction, without complications such as limitation of motion of the knee joint, under correction or over correction,displacement of the section of the osteotomy,internal fixation loosening and fracture. Nineteen patients got an excellent result, 12 good, 5 poor and 2 bad.

CONCLUSIONSupracondylar femoral osteotomy and internal fixation combined with hybrid external fixator is a safe and effective surgery for the treatment of deformity of distal end of femur. This method combines the advantages of internal fixation and external fixation.

Adolescent ; Adult ; External Fixators ; Female ; Femur ; abnormalities ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged

OBJECTIVETo explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade III leg fractures.

METHODSFrom July 2006 to December 2008, 40 cases of Gustilo grade III leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as IIIA in 17 cases, IIIB in 13 cases, and IIIC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IIIA cases and 10 Gustilo IIIB cases at the first operation. But all the Gustilo IIIC cases and 3 Gustilo IIIB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD). Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.

RESULTSThe first operations were completed within 90-210 minutes (170 minutes on average). The blood transfusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included). All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.

CONCLUSIONExternal fixation associated with limited internal fixation to treat Gustilo grade III leg fractures can get satisfactory early clinical therapeutic effects.

Adolescent ; Adult ; Debridement ; External Fixators ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged